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Factors influencing outcome after hepatic portoenterostomy among extrahepatic bile duct atresia patients in Hospital Sultanah Bahiyah, Alor Setar

Devkumar NAMASEMAYAM ; Mohan NALLUSAMY

The Medical Journal of Malaysia.2017;72(6):329-332.

Introduction: Biliary atresia implies high risk of mortality ifnot diagnosed and treated early. We undertook this study toassess the prognostic factors affecting the outcome ofKasai surgery.Methods: A retrospective clinical study was conductedamong 58 patients from Hospital Sultanah Bahiyah AlorSetar. Data were analysed with logistic regression analysisusing SPSS. Factors studied included age during surgery,bile duct diameter at the porta hepatic, race of patient,preoperative total bilirubin level and cholangitis. Thesefactors were analysed to determine its significance as aprognostic factor affecting the outcome of Kasai surgery.Results: Older age group above 56 days of life, bile ductdiameter at porta hepatis measuring <50µm, pre-operativetotal bilirubin >10mg% and cholangitis were found to bepoor prognostic factors from univariate regression analysis.Variables having p value<0.025 were analysed using themultivariable regression analysis. Only age of patient anddiameter of bile duct at the porta hepatis were eligible forthis analysis. The final analysis showed that age 57 days oflife and above (adjusted odd's ratio (aOR) = 9.412, p value =0.042, 95% confidence interval (95%CI) = 1.079 to 82.104) andbile duct diameter <50µm (aOR = 13.812, p value = 0.016,95%CI = 1.616 to 118.042) were significant factors affectingthe outcome.Conclusion: In conclusion, age of patient 56 days of life andyounger and diameter of bile duct at porta hepatis ≥50µmgave a significantly better outcome after Kasai surgery.

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Health-seeking behaviour among patients with faecal incontinence in a Malaysian academic setting

April Camilla ROSLANI ; Rajeshwary RAMAKRISHNAN ; Soraya AZMI

The Medical Journal of Malaysia.2017;72(6):333-337.

Background: Faecal incontinence (FI) is not a commonpresenting complaint in Malaysia, and little has beenpublished on this topic. Since it is a treatable condition, agreater understanding of factors contributing to healthseekingbehaviour is needed in order to plan effectiveprovision of services.Methods: A survey of 1000 patients and accompanyingrelatives, visiting general surgical and obstetrics andgynaecology clinics for matters unrelated to FI, wasconducted at University Malaya Medical Centre betweenJanuary 2009 and February 2010. A follow-up regressionanalysis of the 83 patients who had FI, to identify factorsassociated with health-seeking behaviour, was performed.Variables identified through univariate analysis weresubjected to multivariate analysis to determineindependence. Reasons for not seeking treatment were alsoanalysed.Results: Only eight patients (9.6%) had sought medicaltreatment. On univariate analysis, the likelihood of seekingtreatment was significantly higher among patients who hadmore severe symptoms (OR 30.0, p=0.002), had incontinenceto liquid stool (OR 3.83, p=0.002) or when there was analteration to lifestyle (OR: 17.34; p<0.001). Nevertheless, theonly independently-associated variable was alteration inlifestyle. Common reasons given for not seeking treatmentwas that the condition did not affect patients’ daily activities(88.0%), “social taboo” (5.3%) and “other” reasons (6.7%).Conclusions: Lifestyle alteration is the main driver of healthseekingbehaviour in FI. However, the majority do not seektreatment. Greater public and physician-awareness on FIand available treatment options is needed.

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Assessment of the level of knowledge of colorectal cancer among public at outpatient clinics in Serdang Hospital: a survey based study

Pan YAN ; Chieng Jin YU ; Ahmad Amirul Hafiz Haris ; Ang Shih YUAN

The Medical Journal of Malaysia.2017;72(6):338-344.

Objectives: Colorectal cancer (CRC) is one of the mostcommon gastrointestinal cancers in the world. In the AsiaPacificregion, it is the fastest emerging gastrointestinalcancer. Level of awareness on CRC warning signs and riskfactors in the rural population of Malaysia is reported of verylow. The aim of this study was to assess the level ofknowledge of CRC among the public at medical outpatientclinics in Serdang Hospital. The association between sociodemographicfactors with level of knowledge among therespondents was further studied.Study design: A study was conducted among the non-CRCpatients’ relatives accompanying their relatives to themedical outpatient clinics in Serdang Hospital from 1st Aprilto 31st August 2016. The study was carried out with clustersampling method.Methods: The respondents were assessed using validatedand modified Cancer Awareness Measures (CAM)questionnaire consists of three parts which are knowledgeon warning signs, knowledge on risk factors and sociodemographicfactors. All data were analysed using IBMSPSS Statistics 21.0.Results: Altogether 308 subjects completed thequestionnaires. It was shown high percentage of goodknowledge for warning signs and risk factors of CRC amongthe respondents. A significant association between agegroups and level of income with level of knowledge onwarning signs was observed.Conclusions: The level of knowledge of CRC among thegeneral public in Serdang Hospital was sufficient. Therespondents with higher income or younger age had higherlevel of knowledge regarding CRC.

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Clinical features and prognostic factors of cutaneous vasculitis among dermatology patients in Johor Bahru, Malaysia

Latha R SELVARAJAH ; Siew Eng CHOON ; Kwee Eng TEY ; Yong Nian CHEE

The Medical Journal of Malaysia.2017;72(6):345-349.

Background: Cutaneous vasculitis is common, yet the riskfactors for its chronicity have not been established.Objective: To describe the clinical spectrum and identify riskfactors for chronicity of cutaneous vasculitis.Methods: Retrospective data analysis of 275 patientsdiagnosed with cutaneous vasculitis from January 2008 toDecember 2013.Results: The mean age was 33.7 (±17.89) years, with femalepredominance. The majority of patients were Malays (67.3%).Skin biopsy was performed in 110 (40%) patients. Thecommonest sign was palpable purpura (30.6%). Theaetiology remained elusive in 51.3% of patients. Commonidentifiable causes include infection (19.7%) and connectivetissue disease (10.2%). Extracutaneous features were notedin 46.5% of patients. Erythrocyte sedimentation rate andantinuclear antibody were raised in 124 of 170 and 27 of 175patients with documented results respectively. Cutaneousvasculitis was the presenting symptom in seven patientswith newly diagnosed systemic lupus erythematosus. AntiStreptolysin O Titre was positive in 82 of 156 patients withdocumented results. Despite antibiotics, 31.7% of them hadchronic lesions. Prednisolone alone was used in 20% ofpatients while 16.4% needed steroid-sparing agents. Mostpatients who needed systemic therapy (62%) hadunidentifiable aetiology. Among the 155 patients whoremained under follow up, 36.4% had chronic disease, onepatient succumbed due to septicaemia, and the rest fullyrecovered within three months. The presence of ulcerativelesion was significantly associated with developing chronicvasculitis (p=0.003).Conclusion: The clinical spectrum of cutaneous vasculitis inour population was similar to other studies. Ulcerativelesion predicts a chronic outcome

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Psychometric properties of the Malay-translated General Practice Physical Activity Questionnaire among shipyard workers

Arma NOOR ; Rosnah ISMAIL ; Noor Hassim ISMAIL

The Medical Journal of Malaysia.2017;72(6):350-355.

Background: The General Practice Physical ActivityQuestionnaire (GPPAQ) is a validated and reliable screeningtool to measure the level of physical activity in adults.However, it has never been translated and validated inMalaysian population. This study aimed to translate theGPPAQ into Malay language and to evaluate thepsychometric properties of the Malay-translated GPPAQamong shipyard workers.Methods: The original English version of GPPAQ wastranslated forward and backward into Malay version byexperts. The final version of the Malay-translated GPPAQwas then tested for validity and reliability. A cross-sectionalstudy design was performed and systematic randomsampling was used to select respondents. Construct validityand internal consistency of the Malay-translated versionwere tested using exploratory factor analysis andCronbach’s alpha respectively.Results: Sixty-two male shipyard workers participated inthis study. The GPPAQ showed good factor loading valuesfor all items (0.608-0.834). The exploratory principalcomponent factor analysis delineates all seven items intotwo factors with variance of 41.65%. The Cronbach’s alphavalue was good with 0.81, 0.84 and 0.76 for total scale, factor1 and factor 2 respectively.Conclusion: The Malay-translated version of GPPAQ hashigh psychometric properties. Therefore, it is a validinstrument to assess physical activity among Malaysianworking population, particularly in male shipyard workers.

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Evaluation of visual outcomes after toric intraocular lens implantation

Hui Ruan NG ; Chon Han GOH ; You Siang NGIM ; Juliana JALALUDDIN

The Medical Journal of Malaysia.2017;72(6):356-359.

Purpose: To evaluate postoperative visual acuity, refractivestatus and rotational stability of toric intraocular lens (IOL)in correcting pre-existing corneal astigmatism.Methods: A total of 69 patients with topographic cornealastigmatism of 1.0 Diopter (D) and above who underwentcataract surgery between June 2015 and December 2016were included in this retrospective observational study. Allpreoperative toric IOL calculations were performed usingimmersion biometry. Appropriate formula to calculate toricIOL power was applied (SRK/T, Holladay 1 or Hoffer Qformula). All patients undergone similar uncomplicatedphacoemulsification with implantation of AcrySoft IQ SN6ATtoric IOL of different powers. Visual outcome, refractivestatus and axis of lens were evaluated at six weekspostoperatively. Ethical approval from the Ministry of HealthMedical Research Ethics Committee was obtained prior tocommencement of study.Results: The mean refractive astigmatism decreased from1.69 D ±1.10 (SD) to 0.81 D ± 0.40 (SD) at six weekspostoperatively. The mean postoperative sphericalequivalent was at -0.37 D ±0.64 (SD). Mean LogMAR foruncorrected and corrected distance visual acuity in sixweeks postoperative patients was at 0.29 ±0.16 (SD) and 0.12±0.12 (SD) respectively. Intraoperative to 6 weeks ofpostoperative comparison of IOL axis alignment showed lowlevels of rotation (mean 3.21 ±2.52 degrees).Conclusion: Cataract surgery with implantation of toric IOLwas stable and effective in improving pre-existing regularcorneal astigm

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A case of immune thrombocytopenic purpura with prolonged aPTT time: A clotter hidden in a bleeder?

Lee Mei HAN ; Khoo Pei JIE ; Gew Lai TECK ; Ng Chen FEI

The Medical Journal of Malaysia.2017;72(6):365-366.

We report the case of a 23-year-old woman who presentedwith prolonged menstruation and multiple bruises on thelimbs and trunk. Investigations revealed severethrombocytopenia and deranged coagulation profile withmarkedly prolonged activated partial thromboplastin time(aPTT). Lupus anticoagulant, anti-cardiolipin antibody andanti-beta-2-glycoprotein 1 antibody were positive. She wasdiagnosed with Immune Thrombocytopenic Purpura (ITP)with positive antiphospholipid antibody serology and givena course of intravenous methylprednisolone and taperingdoses of oral prednisolone. She was steroid free and had nobleeding or thrombotic event over two years follow up.

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Necrotising pneumonia: A pneumonia that may need surgical intervention

Ooi Shin YI ; Lee Shen WEI

The Medical Journal of Malaysia.2017;72(6):367-369.

Pneumonia is primarily a disease that is usually managedmedically with antibiotics. However, in rare cases it mayprogress to necrotising pneumonia, which is an uncommonbut severe complication of bacterial pneumonia. This caseillustrates a typical case of necrotising pneumoniacomplicated with parenchymal and pleural complicationsuch as empyema, pneumothorax with possiblebronchopleural fistula. Early consultation with thoracicsurgeon can be life-saving.

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A comparison of dabigatran and warfarin for stroke prevention in elderly Asian population with nonvalvular atrial fibrillation: An audit of current practice in Malaysia

Yap Swee HIEN ; Ng Yau PIAO ; Roslan ASLANNIF ; Kolanthaivelu JAYAKHANTAN ; Koh Kok WEI ; P’ng Hon SHEN ; Boo Yang LIANG ; Hoo Fan KEE ; Yap Lok BIN.

The Medical Journal of Malaysia.2017;72(6):360-364.

Introduction: Atrial fibrillation (AF) is the most commoncardiac arrhythmia with significant morbidity and mortalityin relation to thromboembolic stroke. Our study aimed toevaluate the safety and efficacy of dabigatran in strokeprevention in elderly patient with nonvalvular AF with regardto the risk of ischemic stroke and intracranial haemorrhage(ICH) in real-world setting.Methods: A retrospective cohort study of 200 patients ondabigatran and warfarin from January 2009 till September2016 was carried out. Data were collected for 100 patients ondabigatran and 100 patients on warfarin.Results: The mean follow-up period was 340.7±322.3 daysfor dabigatran group and 410.5±321.2 days for warfaringroup. The mean time in therapeutic range (TTR) was52±18.7%. The mean CHA2DS2 -VASc score for dabigatrangroup was 4.4±1.1 while 5.0±1.5 for warfarin group. None indabigatran group experienced ischemic stroke compared toone patient in warfarin group (p=0.316). There was onepatient in dabigatran group suffered from ICH compared tonone in warfarin group (p=0.316). Four patients in warfaringroup experienced minor bleeding, while none fromdabigatran group (p=0.043).Conclusion: Overall bleeding events were significantly lowerin dabigatran group compared to warfarin group. In thepresence of suboptimal TTR rates and inconveniences withwarfarin therapy, non-vitamin-K antagonist oralanticoagulants (NOAC) are the preferred agents for strokeprevention in elderly Asian patients for nonvalvula

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Adult human metapneumovirus encephalitis: A case report highlighting challenges in clinical management and functional outcome

Tan Yeow LENG ; Wee Tze CHAO

The Medical Journal of Malaysia.2017;72(6):372-373.

We report a rare case of adult human metapneumovirus(HMPV) in a healthy 32-year-old man. There was dramaticdeterioration in his condition developing pneumonia withType-I respiratory failure and encephalitis. He neededmechanical ventilation in the intensive care setting and wastreated with intravenous ribavirin. Post-extubation heremained severely physically and cognitively impaireddespite rehabilitation. Treatment of HMPV pneumonia is atpresent, still without specific antiviral therapy. ManagingHMPV-encephalitis remained supportive and challenging.More definite treatment strategies are needed.

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